Children's Hospital, University of Wuerzburg, Josef-Schneider-Strasse 2, 97080 Wuerzburg, Germany.
Institute of Epidemiology and Medical Biometry, University of Ulm, Schwabstrasse 13, 89075 Ulm, Germany.
J Cyst Fibros. 2014 Jan;13(1):80-5. doi: 10.1016/j.jcf.2013.06.001. Epub 2013 Jun 25.
An annual oral glucose tolerance test (OGTT) has become part of standard care in cystic fibrosis (CF) to screen for CF-related diabetes (CFRD). The objective of this study was to determine predictors for future CFRD derived from an OGTT.
Data were collected from 2001 to 2009 during a longitudinal prospective study on "Early Diagnosis of Diabetes Mellitus in CF Patients, trial number NCT00662714". The 1093 patients included in the analysis had at least two valid OGTTs each and no CFRD at the first glucose challenge. Normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and CFRD were defined using WHO criteria. In a subsample of 521 patients, the NGT group was further divided into patients with a 1-hour glucose level >11.1 mmol/l (indeterminate glucose tolerance -- INDET) and those with a lower level (no-INDET). Logistic regression analysis was used to identify predictors from the first OGTT for future diabetes.
Compared with NGT (n = 838), IFG (n = 70; odds ratio [OR], 95% confidence interval: 2.92, 1.60-5.33) and IGT without IFG (n = 155, OR 2.37, 1.48-3.79) were both significant and independent risk factors for future CFRD. Patients with IGT and IFG (n = 30) had the highest risk (OR 5.30, 2.32-12.10). In the subsample analysis, INDET (n = 116) was associated with a significantly increased risk for future CFRD compared with no-INDET (n = 269; OR 2.81, 1.43-5.51).
In this large study, IFT, IGT, and INDET were all predictors of future CFRD. The OGTT in patients with CF should include a 1-hour post-challenge value.
在囊性纤维化（CF）中，每年进行一次口服葡萄糖耐量试验（OGTT）已成为标准护理的一部分，以筛查 CF 相关糖尿病（CFRD）。本研究的目的是确定 OGTT 中预测未来 CFRD 的因素。
该研究数据来自于 2001 年至 2009 年期间一项名为“CF 患者糖尿病早期诊断，试验编号 NCT00662714”的纵向前瞻性研究。在分析中纳入的 1093 例患者均至少进行了两次有效的 OGTT，且在首次葡萄糖挑战时无 CFRD。采用世界卫生组织（WHO）标准定义正常糖耐量（NGT）、空腹血糖受损（IFG）、糖耐量受损（IGT）和 CFRD。在 521 例患者的亚组中，NGT 组进一步分为 1 小时血糖水平＞11.1mmol/l（不确定糖耐量--INDET）和较低水平（非-INDET）的患者。采用 logistic 回归分析从首次 OGTT 中确定预测未来糖尿病的因素。
与 NGT（n=838）相比，IFG（n=70；比值比[OR]，95%置信区间：2.92，1.60-5.33）和无 IFG 的 IGT（n=155，OR 2.37，1.48-3.79）均为未来 CFRD 的显著且独立的危险因素。IFG 和 IGT 患者（n=30）的风险最高（OR 5.30，2.32-12.10）。在亚组分析中，与非-INDET（n=269；OR 2.81，1.43-5.51）相比，INDET（n=116）与未来 CFRD 的风险显著增加相关。
在这项大型研究中，IFT、IGT 和 INDET 均为未来 CFRD 的预测因素。CF 患者的 OGTT 应包括 1 小时后挑战值。
